Thursday, August 13, 2009

Exotics extravaganza (cockatoos, bunnies, reptiles oh my!)

My first weekend was a good one, but it was thoroughly exhausting. I had a surgery both nights - a c-section on the first one, an enucleation on the second. Both went well, although I was surprisingly nervous. Perhaps because it's been a while since I wielded a scalpel.

At any rate, Sunday morning, I had all my cases wrapped up, transferred to the day ER doc, and was ready to head home. An owner calls and asks if we will see his bird. Neither of the other ER docs are comfortable with birds, so that left me. I asked the technician to tell the owners to go to the nearby specialty clinic. As it turns out, however - all of the avian/exotics docs are currently out of town at the AAV (Annual Association of Avian Vets). No one else in the area was open to see the sick birdie.

I sighed and told them to come on in. I can't resist a bird in need of medical attention. Especially when there is no one else to see it.

It was an interesting case, as it turns out - a cockatoo with neurological disease. He wasn't able to grip with his feet, he kept falling, and occasionally, he was maybe having seizures. After looking him over, I explained to the anxious owners that my primary differentials were heavy metal toxicity (lead, zinc poisoning) and proventricular dilatation disease.

Birds that free roam in houses (as my patient did) often eat things they shouldn't, chew paint, chew blinds, chew windowsills - you get the picture. Any time a bird comes in with neurological signs, ingestion of a metallic object has to be high on the list of possible causes. Yet, I've never actually had one that I xrayed have actual metal in the body.

This was to be my first. Imagine my delight when I saw a small metal foreign body in the proventriculus and proventricular dilation (a common sequelae to heavy metal toxicity). Thrilled, I began treatment with calcium EDTA (to chelate the metal). My patient did very well, was able to perch and grip, before transferring away to his veterinarian on Monday.

The downside? It took me until 1:30pm Sunday to finish working him up, treating him, and getting him settled. Thus, I had exactly 4.5 hours before I had to be back for the Sunday night shift. I wound up sleeping at work. So, on my first weekend, I was there for almost 40 hours straight. Plus, we had a doctor meeting on Monday morning, after my shift ended. So I was pretty much awake from 5:30pm Saturday through 1:30pm Monday afternoon, with the exception of a 3ish hour nap on Sunday.

Don't worry, it won't become a habit. It was worth it, to fix my cockatoo patient. I also had a bunny patient (with a head tilt) that was very fun (and rewarding) to treat.

I love my new job, by the way. The people are great, the place is well-run, and I'm in charge. Maybe that's my favorite part.

DISCLAIMER

Any similarity between my stories and any person or animal, living or dead, is strictly a coincidence. Names, breeds, sexes, and details of the stories have been changed to protect the guilty and innocent alike.

About Me

I am an emergency veterinarian in North Carolina. Despite the crazy people I deal with, the awful cases of injured and sick animals, and the overall stress of emergency work, I absolutely love what I do. Happily married since I was 20, I have a wonderful husband who has a PhD in Mathematics, and a daughter around whom our world currently revolves. We also have a zoo living in our house that can be alternately wonderful and maddening. There are cats, parrots, and a dog who is very low on the totem pole. Our days are never dull and we are learning to balance the demands of work and family.
If you'd like to contact me: homelessparrot@gmail.com

Human gross-ness

Followers

Medical terminology

Lactate - a salt/ester of lactic acid that is produced as energy for a cell when oxygen levels are low. In critically ill animals, elevated lactate can be an indicator of inadequate blood flow to organs (perfusion), decreased delivery of oxygen, and/or decreased oxygen uptake. Values > 6-7 are usually considered to be poor prognostic indicators for survival.

GI sloughing: when the cells lining the GI tract die (can be secondary to MANY things, including heatstroke) with resulting bloody diarrhea, bacterial translocation into the bloodstream and sepsis

TTJ: transfer to jesus: code for when an animal needs to be euthanized or die

DIC: disseminated intravascular coagulation: a very, very bad thing - when the hemostatic system gets out of whack, and clots start forming in the blood vessels until all clotting factors are wasted. once those are gone, internal hemorrhage ensues, followed by death, usually. also known as "death is coming"

Pleural effusion - fluid contained in the pleural space (chest) - this is not the same as fluid in the lungs (see pulm edema) - in cats can be caused by infection in the chest, heart failure, cancer, FIP, feline leukemia, FIV, and in some cases, the cause is never found (idiopathic)

Anisocoria - unequal pupil size (related to any number of causes including brain damage/head trauma)

Sepsis - refers to a bacterial infection in the bloodstream or body tissues. This is a very broad term covering the presence of many types of microscopic disease-causing organisms.

Nephrectomy - kidney removal

Splenectomy - removal of spleen

Pulmonary edema - condition in which fluid accumulates in the lungs, usually because the heart's left ventricle does not pump adequately ( can be caused by heart failure, electrocution, drowning, too many IV fluids, to name a few)

Tick borne diseases - any of a myriad of diseases transmitted by ticks - including but not limited to Rocky Mtn Spotted fever, Lyme disease, Ehrlichia

Fine needle aspirate - A method of sampling in which a needle is used to suck in cells or tissue bits for diagnoses (good for diagnosing masses/lumps)

Blood glucose - The principal sugar produced by the body from food–especially carbohydrates, but also from proteins and fats; glucose is the body's major source of energy, is transported to cells via the circulation and used by cells in the presence of insulin (normal range in a dog/cat is 75-100)

Diseases I see/treat frequently

Dystocia - difficulty birthing. May be responsive to oxytocin administration (Pitocin, as in people) but may require c-section.

DKA - diabetic ketoacidosis: the extreme end of the diabetic scale. A patient that is diabetic can develop DKA when other diseases make the blood glucose hard to regulate. Other diseases that are commonly associated include urinary tract infection, pancreatitis, pyometra, skin infection, and cancer. In DKA, the body starts metabolizing fat and producing acids that cause a drop in blood pH, nausea, weakness, severe dehydration, electrolyte derangments, and death.

DCM - dilated cardiomyopathy: an idiopathic (cause unknown) cardiac disease in which the heart chambers become very thin/dilated, and cardiac output drops radically. Causes arrhythmias, tachycardia, and sudden death. Seen in large breed dogs like Dobermans, Great Danes, etc.

Lymphoma - cancer of the white blood cells, the most common and treatable form of cancer in dogs

Blocked cat - slang term for a male cat with a plug of mucus and crystals obstructing the urethra (fairly common in male cats) definitely a life-threatening because urine can't get out of the body! If present long enough, causes shock, acute renal failure, hyperkalemia (elevated potassium), coma, and death. Symptoms include straining in the litterbox, yowling while trying to urinate, producing small, bloody drops of urine (also symptoms of feline cystitis, a non-lethal condition)

GDV - stands for gastric-dilatation and volvulus - a condition of large breed, deep-chested dogs (usually) in which the stomach rotates 180 degrees on its axis and thus - nothing can enter or leave, considered the "mother of all emergencies" - it warrants immediate surgery and carries a guarded prognosis

IMHA - immune-mediated hemolytic anemia. A disease in which the immune system attacks the red blood cells and destroys them. It causes profound anemia and is life-threatening. Causes are primary (no known cause) and secondary ( tick borne disease, cancer, and heavy metal intoxication). Treatment is immunosuppression with drugs primarily. Prognosis is guarded at best.